Clinical and economic outcomes of empiric parenteral antibiotic therapy for pneumonia: a retrospective study of 1,032 hospitalized patients

Abstract

The spiraling increase in pharmaceutical costs in hospitals means that the economic aspects of pharmacological therapy can no longer be ignored. The aim of the present study was to evaluate care and cost outcomes following initial therapy with parenteral antibiotics in a hospital setting for the treatment of lower respiratory tract infection (pneumonia and pleurisy with or without complications). From January to December 1996, a total of 1,032 patients were reviewed. The mean age of the patients was 71.9 years (range, 16-100 years). Piperacillin was most frequently prescribed (n=369), followed by ceftriaxone (n=324) and ceftazidime (n=161), among other antibiotics. The clinical success ranged from a maximum of 85.0% and 85.4% for piperacillin and ceftriaxone, respectively, to a minimum of 72.7% and 75.2% for cefodizime and ciprofloxacin, respectively. Differences between the antibiotic regimens emerged for mean prescribed daily doses, therefore the daily cost per administered dose was much lower for antibiotics such as piperacillin or ceftriaxone than for cefotaxime or ceftazidime. Ceftriaxone, at just over 177,840 Italian liras per success, was more cost-effective than other third-generation cephalosporins such as ceftazidime and cefotaxime, whose cost-effectiveness ratios were 420,590 and 272,030 Italian liras, respectively. A comparison of cost ratios for the seven antibiotic regimens evaluated indicates that using ceftriaxone led to a 57.72% cost savings per clinical success compared to using other third generation cephalosporins such as ceftazidime, and a 69.45% savings compared to therapy with ciprofloxacin.